Integrated Medical Account (Neura).

Healthcare access in most developing countries is significantly challenged due to high population densities with limited health care facilities, most of which suffer operational inefficiencies. The COVID-19 pandemic has imposed a significant level of challenge to health care access, especially in developing countries – where scarce health systems are overwhelmed; thus, exacerbating the access challenges faced by the poor and other vulnerable members of the society. Additionally, Health workers cannot always tell when a patient’s condition is about to worsen due to burnouts and lack of information, and patients can arrive at the ICU late. This leads to longer hospital stays and poorer outcomes but there are times when patients could have avoided the ICU altogether had their condition been recognized early.

The Lancet Global Health Commission on High Quality Health Systems found that 5.7 million people die in low and middle-income countries every year from poor quality healthcare and  2.9 million and die from lack of access to care. Additionally, Illegible handwriting can also delay treatment, lead to unnecessary tests and inappropriate doses which, can result in discomfort and death. In 1999, an American cardiologist caused the death of a 42-year-old patient when his prescription of 20 mg Isordil drug was misread by the pharmacist as 20 mg Plendil. In Britain, it is estimated to cause the deaths of up to 30 000 people each year[1].

[1] Sokol, D. K., & Hettige, S. (2006). Poor handwriting remains a significant problem in medicine. Journal of the Royal Society of Medicine, 99(12), 645-646.

The innovation is a low-cost, quality-driven, integrated Artificial Intelligence (AI) enabled medical application (otherwise called Neura) developed via integration of applications existing under hospital management system, comprising various independent applications, (namely: e-social, e-pharmaceutical, e-laboratory, e-physician, e-practitioner, e-emergency and e-insurance applications) and linked remotely to the repository of individuals’ Electronic Health Records (EHR)  with a view to ensuring collaboration among various healthcare subsystems, for improved health care access by the poor and marginalized population and overall efficiency of the healthcare system. The hardware component of the innovation (otherwise called Neuroset) is an electronic tablet with embedded micro-printer for the generation of hardcopy medical reports in real-time; and is built from locally sourced waste plastic materials which constitutes about 50 % of its casing, making it environmentally friendly device in event of its large-scale production.

Neura looks at variables in a patient’s medical account, including lab results and vital signs, and determine whether the patient is at a low, moderate or high risk of needing Intensive Care Unit. This will reduce mortality rates in individuals who need emergency attention as it will predict to be critical patients. Neura algorithm dichotomizes users by pregnancy status and this can lead to fast, reliable care. Practitioner in proximity identifies practitioners in communities during emergencies like at night. The patient management-hospital software monitors patients in facilities, dichotomizes patient needing Intensive treatment and optimizes hospital resources like labour and medical supplies to best work on patients including mothers, neonates, and children in critical condition, this improves access to the right information at the right time and right place in order to deliver right care. This is of utmost importance in healthcare, where a single decision can make the difference between life and death. 

Our beneficiaries  include hospitals, hospices and other long-term care facilities in low-to-middle income countries, especially in sub-Saharan Africa. Sub-Saharan Africa has a poverty (below $2 per day) rate of about 41%, and accounts for 27 of the 28 poorest countries in the world[1].  Our target market is the sub-Saharan African countries, with a population of over 1.1 billion people, most of who are living below poverty line, with scarce and poor health facilities and low per-capita health care expenditures. Prospective beneficiaries of the system will include patients, medical personnel and residents in hospitals, the community, hospices and other long-term care facilities in low-to-middle income countries, especially in sub-Saharan Africa with a population of over 1.1 billion and density (Km2) of 50.10. Our pilot testing is in Uganda with a population of over 45 million and 229 per Km2 population density. The primary outcome is to achieve improved healthcare system that is accessible to and affordable by the poor in the community while the secondary outcome is wellbeing and community development.

Health workers cannot always tell when a patient’s condition is about to worsen, and patients can arrive at the ICU late. This leads to longer hospital stays and poorer outcomes, patients could have avoided the ICU altogether had their condition been recognized. The proposed innovation (Neura) would help to reduce the level of mortalities using personalized prescription and recommendations of patients’ conditions through medical test results and other vital signs, to determine the level of care (e.g. low, moderate or high risk) required by the patient at Intensive Care Unit. This will reduce mortality rates especially in vulnerable individuals namely : neonates, pregnant women, health workers. The deployment of Neura on Neuroset is bound to minimize cases of Iatrogenic ailments, this will resultantly improve health outcomes in congested and overwhelmed healthcare systems. This innovation is expected to impact  over 5,000 patients in Uganda, anually.

[1] Brooklings (2018): Africa in Focus - Figure of the Week: Understanding Poverty in Africa., Available online at https://www.brookings.edu/blog/africa-in-focus/2018/11/21/figure-of-the-week-understanding-poverty-in-africa/

Our team is composed of innovators with skills in programming, and Computer Aided Designs providing a rich resource to scale this project.

Faith-Michael Uzoka, Prof of Comp Science @ Mount Royal University, Calgary, with extensive research experience in med DSS & tech adoption & innovation.

Dr.Peter Zeh, Assistant Prof in Healthcare & Research Methodologies, Coventry University, with researhch focus on multimorbidity, telehealth, implementation science.

Mugisha Gift, system Developer working on the integration of the Neura project.

Dr. Samali V. Mlay, Senior Lecturer and Researcher at Makerere University Business School in the area of sustainable IT.

Dr. Lucy Amaniyo, Paediatrician and public health practitioner with a passion for reducing health disparities among vulnerable children.

The system development team consists of one computer scientist (Prof. Faith-Michael Uzoka) from MRU, We will also hire four Research Assistants (two from MRU and two from Uganda), who will be mainly involved in systematic literature review, focus group interactions/data collection, coding and system evaluation.  The  physician will be deeply involved in requirements analysis and also contribute to the system design since she is an expert in the problem domain in Africa. 

Over the past decade, we have developed medical models and systems for enhancing health-care access in developing countries. The outcomes of our research have been published in high impact computing and medical information systems outlets such as: International Conference on Medical and Health Informatics, International Conference on Computational Science and Computational Intelligence, Int.

Journal of Medical Engineering and Informatics, International Conference on e-Health, Computer Methods and Programs in Biomedicine, Medical and Care Compunetics, Expert Systems with Applications and International Journal of Health Care Quality Assurance.

We plan to disseminate the outcomes of this project in the following venues:

• Two post-project workshops for: i) institutional users, and ii) individual users (in Uganda)
• At least one journal publication. A target journal is:
• At least, one conference presentation. A target conference is:     

Journal of Medical Systems, which “provides a forum for the presentation and discussion of the increasingly extensive applications of new information systems techniques and methods across all health care settings”. https://www.springer.com/journ...

IEEE International Conference on Healthcare Informatics. ICHI is “the premier community forum concerned with the application of computer science principles, information science principles, information technology, and communication technology to address problems in healthcare, public health, and everyday wellness. The conference highlights the most novel technical contributions in computing-oriented health informatics and the related social and ethical implications” https://ichi2021.institute4hi....

As with any innovation scale-up, we anticipate some challenges, most of which would relate to anticipation of partnership involvement and funding. It is our expectation that Solve, ministry of health, government hospitals and private healthcare companies such as pharmaceuticals and private hospitals, in the respective countries will partner with us, providing about 10% of the financial support, plus the legal framework for system implementation. There is a possibility that we might encounter regulatory challenges in the intended countries. To mitigate the risk, we will enter into prior discussions with the health authorities and obtain all implementation approvals prior to scaling. Obviously, the models and policies of health care operations and funding vary across the countries, especially across the various sub-Saharan African regions. We intend to strike collaborations with other innovators, researchers and health professionals in the Solver teams to further refine our business model and improve our system for wide scale implementation, as a strategy for navigating the contextual peculiarities of the countries.

We may meet challenges regarding data collection especially when dealing with human data access to hospitals.We will obtain ethical clearance from the Makerere University School of public Health Research and Ethics Committee. Written permission to carry out the research will also be obtained from the management of the respective health facilities. The objectives, benefits and risks of the study will be explained to the prospective study participants and informed consent sought before interviews. Confidentiality will be observed when collecting and handling data and anonymous identifiers will be used in the transcribed data.

We are seeking 100,000 USD to scale up our services into more health centers ,the population and hospices.

Unlike other systems like rocket health, Neura comes with a dedicated and optimized tablet called Neuroset which has an embedded small printer that can print medical data in real time, to solve the issue of poor handwriting by most practitioners especially doctors and can run continuously on solar power far away from the national grid. It is powered by advanced analytics, machine learning and artificial intelligence techniques thus providing an actionable insight to support decision making, provide high quality patient care, respond to real-time situations and save more lives on the clinical front; as well as optimise the use of resources, improve the processes and services and reduce the costs on operational and financial front. The informative data can be accessed both locally and globally to all practitioners with authentication to the patient’s national account  making referrals to different countries easily  executed as practitioners from the native countries of the patient and the current country can share medical data in real time and get all records on the tap of their fingertips from the repository of individualized medical data account thus creating a unique and novel system.

The national medical account of each citizen that we are creating will establish virtual hospitals as many people visit stand alone facilities like individual pharmacies, laboratory centres, consultation centres, this makes it so hard to track mistakes like wrong dosage, expired drugs and wrong diagnosis making it the only Integrated system here in Uganda that encompasses the whole healthcare ecosystem.

Hospitals will be more connected. The personal medical account repository will be implemented and the vast repository created will be used in providing information for national planning like procurement of drugs, enrolment of new medical stuff and surveillance of Antimicrobial resistant strains. Research will be simplified and accurately carried out as the vast repository created will provide statistical data that will be used by research organisations like the number of people who contract malaria daily etc hence reducing research costs and improving the accuracy of information thus disrupting the research market.

We plan to serve about  1.5 million people in the next 5 years by defaulting them onto our system.

We expect rolling out the product to ten more health facilities for the next year in Uganda where most people are living below poverty line (i.e., below $2 per day), with low per-capital health care expenditures. We will use both gross (i.e., price of the product × number of units sold) and net (i.e., gross revenue - commissions - discounts – returns) revenue to summarize the financial health of our innovation. We intend country wide scaling by partnering with ministry of health, national associations of medical practitioners; private and public hospitals.  The system will be evaluated by 1000 patient users and 60 medical practitioners and scaling up effected in rural health Centres III, IV &V (1000). Registration of individual citizens will be at birth, registration hot spots and on hospital admissions. The users’ adoption of our system will be assessed using the medical application evaluation framework (Wright & Sittig, 2008; New Zealand 2017) with a focus on architectural, usability, functionality, effectiveness and efficiency features. In the long run, we will additionally rate the overall project success in terms of number of medical facilities that adopted the system, number of individual users and improvement in access – to be determined through the adoption survey. 

The users’ adoption of our system will be assessed using the medical application evaluation framework (Wright & Sittig, 2008; New Zealand 2017) with a focus on architectural, usability, functionality, effectiveness and efficiency features. In the long run, we will additionally rate the overall project success in terms of number of hospitals/clinics and medical facilities that adopted the system, number of individual users and improvement in access – to be determined through the adoption survey.

We plan to disseminate the outcomes of our study in the following venues:

1.         Two post-project workshops for: i) institutional users, and ii) individual users (in Uganda)

2.         At least one journal publication. A target journal is:

Journal of Medical Systems, which “provides a forum for the presentation and discussion of the increasingly extensive applications of new information systems techniques and methods across all health care settings”. https://www.springer.com/journ...

3.         At least, one conference presentation. A target conference is:       

IEEE International Conference on Healthcare Informatics.

The users’ adoption of our system will be assessed using the medical application evaluation framework (Wright & Sittig, 2008) with a focus on architectural, usability, functionality, effectiveness and efficiency features. In the long run, we will additionally rate the overall project success in terms of # of hospitals/clinics and medical facilities that adopted the system, number of individual users and improvement in access – to be determined through the adoption survey. In addition, our health insurance subsystem will be evaluated in terms of the percentage of intended users that are served by the insurance scheme.

We shall conduct the evaluation in two phases, formative (Phase I) and summative (Phase II).

Formative Evaluation Phase

The formative evaluation phase, will be carried out periodically (every 2 weeks) to assess adherence of the implementation process to the project’s objectives and will have a timeline of between 6months to 1year.

Key assumptions to be made during formative measurement include:

There will be early ethical approval for this study by concerned local health institutions.

There will be willingness of health authorities to grant access to medical records

There will be availability of local legislative provisions to use the system.

The evaluation metrics that will be used to measure  success of the project during the formative phase include:

Measure contextual relevance of the study to host communities.

Periodic assessment of actual number of iatrogenic cases or similar events that occur while the system is used. Secondary data will also be collected from health authorities regarding number of errors prior to project implementation. This will form the baseline for trend analysis of hospital Iatrogenisis.

Measure the economic status, age ranges, and racial(ethnic) background of people receiving services.

Measure the interest of the local authorities to support and adopt the intervention program in health centres.

Summative Evaluation Phase

The summative phase will be administered as an outcome-based measurement within 1–2-year timeline.

 We shall  systematically employ the mix of   qualitative and quantitative  data  in consistence with Guetterman et al. (2015).  The qualitative data will be collected  via  questionnaires  whereas   semi-structured interviews respectively.

Key assumptions to made during the summative measurement include:

• At least 3000 patients must have accessed the facility.
• At least 100 health administrators from host regions join project review team.
• At least 60% of sampled health workers and patients of host region show knowledge about the project.
• ) Post-assessment of the actual record of Iatrogenisis cases within project implementation timeline will be lower than that observed in the secondary data.

Some summative evaluation metrics that will be used include;(i) User acceptability and adoption:

• Measure improvement in access; number of patients, health providers that have accessed the technology within timeline.
• Measure the number of health administrators that joins the project review team.
• User satisfaction in terms of experience with the technology.
• Ease of use of the system.
• effects of facilitating conditions.
• Measure infection susceptibility rate at facility.
• Records of confirmatory tests of infection cases for prospective in.

Uganda and other Middle and low-income countries are faced with health disparities such as poor patient record management, antimicrobial resistance, poor adherence to medication and low doctor: patient ratios.

The goal of the system is to improve access to healthcare,  medical errors, improve adherence to medication, improve patient record management and enhance the effectiveness and efficiency of our hospitals in meeting the basic clinical needs of patients by reducing the work load of the medical personnel. Our anticipated community impact is a reduction of the morbidity and mortality rates as a result of efficient healthcare services and antimicrobial resistance surveillance and mitigation. These resultantly will increase the lifespan and productivity.

We are striving to develop a system that is affordable for the low-income countries. Mass awareness will be raised through conferences, advertisements, lobbying with government and medical practitioners among others to increase its adoption. The adoption of our technology will be evaluated using the enhanced technology adoption model developed by (Sabi, Uzoka, Langmia and Njeh 2016), which take cognizance of contextual factors.

Limitations include: lack of funding for prototype enhancement, and procurement of materials and testing. For us to achieve our impact, we make the following assumptions; acquisition of funds to develop the tool, support from medical practitioners, clearing government health regulatory process, computer literacy skills to use the tool, availability of electricity and/or alternative sources of energy and in this case our tablet will have an embedded solar panel to have a continuous usage even in the rural setting.

Agile development methodology will be utilized in iterative and modular systems design, coding and testing.  The outcome will be the Hospital Management system, the personal national medical account, e- social subsystem, e-pharmaceutical sub-system, e-laboratory subsystem, e-practitioner subsystem and e-med emergency insurance subsystem all running on the Neuroset device. The system will be evaluated by 1000 patient users and 60 medical users (6 from each of ten hospitals). The users’ adoption of our system will be assessed using the medical application evaluation framework, with a focus on architectural, usability, functionality, effectiveness and efficiency features. Registration of individual citizens will be at birth, registration hot spots and when people get sick and visit a hospital.

Neura is powered by advanced analytics, machine learning and artificial intelligence techniques thus providing an actionable insight to support decision making, provide high quality patient care, respond to real-time situations and save more lives on the clinical front; as well as optimise the use of resources, improve the processes and services and reduce the costs on operational and financial front. Healthcare stakeholders can harness the power of data not only for analysis of historical data, but also for predicting future outcomes and for determining best action for current situation. The informative data can be accessed globally to all practitioners with authentication to the patient’s national account making it very unique and useful.

Neura  facilitates  cutting edge technology that will use a Brain-Computer Interface for patient monitoring  in the extremely weak with very high lethargic levels ,the power of the mind will be harnessed to construct emergency conversations and monitoring data from the patient’s scalp to  practitioners device by using an advanced non intrusive electroencephalogram to intercept and translate brain signals into meaningful texts and voice ,this is  important where first hand  information is required from babies ,the dumb and extremely weak as they can’t speak.

The national medical account of each citizen that we are creating will establish virtual hospitals as many people visit stand alone facilities like individual pharamacies,labaratory centers,consultation centers,this makes it so hard to track mistakes like wrong dosage, expired drugs and wrong diagnosis. Health care services will be closely monitored from diagnosis to dispensing of drugs and patient follow up thus creating a vast repository of information opportunity to have a holistic understanding of the patient’s health. Using advanced technologies over this data will enable access to the right information at the right time and right place in order to deliver right care. This is of utmost importance in healthcare, where a single decision can make the difference between life and death.

Neuroset has an embedded small printer that can print medical data, to solve the issue of poor handwriting by most practitioners especially doctors unlike other hospital management software. 

Gender will be a major variable in most of the systems and results analysis interfaces, especially for lab results, pharmaceutical transactions and e-medical support. Our data collection instruments, and resulting application will dichotomize users by gender and pregnancy status and this will favor pregnant mothers in accessing fast, reliable care in their proximity. Some components of our system such as social emergency insurance will be focused on maternal health that is predominantly composed of females. Mothers in labour will be mostly favoured.

Data of trans and gender diverse people who may feel forced to hide their identities may be privileged to do so using relevant system’s functionalities, since they are at greater risk of verbal and physical abuse and social exclusion.

Our team is also composed of four female team members and, so gender considerations will paramount during research and development.

Carrying out research is a tedious and very expensive process, We will sell high quality non confidential statistical data to governments and research organisations from the vast repository contained in the personal medical account , this will make it easy for researchers to access high quality data at a cheap price such as the number of individuals who contract malaria daily.

The following are potential sources of funds: i) Ugandan Ministry of Health; ii) Canadian Institute of Health Research, and iii) New Frontiers in Research Funds, Canada. Our Co-Principal Investigator is a Professor in Canada, and has obtained similar funding for development of solutions for improvement of health care access in Africa. More funding will be obtained from individuals using eMed social and market place to sell their medical merchandise especially drugs. Non confidential statistical data will be harnessed by research organisations and this will give us an investment to keep the project running. 

The Neuroset  tablet will cost around €200. The software will be leased to the government at a rate of 10 dollars a patient for 6 months . The e-medical social ,e-Marketplace, e-practitioner will be accessed  by the general public for free

For sustainability, We will sell non confidential statistical data to governments and research organisations, this will make it easy for them to access high quality data at a cheap price such as the number of individuals who contract malaria daily.

The following are potential sources of funds: i) Ugandan Ministry of Health; ii) Canadian Institute of Health Research, and iii) New Frontiers in Research Funds, Canada. Our Co-Principal Investigator is a Professor in Canada, and has obtained similar funding for development of solutions for improvement of health care access in Africa. More funding will be obtained from individuals using eMed social and market place to sell their medical merchandise especially drugs. Non confidential statistical data will be harnessed by research organisations and this will give us an investment to keep the project running. 

The Neuroset  tablet will cost around $150.
The software will be leased to the government at a rate of 10 dollars a patient for 6 months .
The e-medical social ,e-Marketplace, e-practitioner will be accessed  by the general public for free

We received $14,000 from FST ,Mount Royal University, Canada for system development and evaluation. 

Life link Medical centre, Seeta,Gwafu, Uganda that runs our vitex system to serve over 5,000 patients annually with an annual revenue of $2000.